Friday, July 29, 2011

Small-Town Doctors Made in a Small Kansas Town

The eight students at the University of Kansas medical school in Salina. Front, from left, Rany Gilpatrick, Claire Hinrichsen and Sara Ritterling; second row, Kayla Johnson, Erik Dill and Tyson Wisinger; back, Jill Corpstein and Daniel Linville.

SALINA, Kan. — This state, so sparsely populated in parts that five counties have no doctors at all, has struggled for years to encourage young doctors to relocate to rural communities, where health problems are often exacerbated by a lack of even the most basic care.

On Friday, anew medical school campusopened here to provide a novel solution to the persistent problem: an inaugural class of eight aspiring doctors who will receive all their training in exactly the kind of small community where officials hope they will remain to practice medicine.

The new school, operated by theUniversity of Kansas, is billed as the smallest in the nation to offer a full four-year medical education. More important, supporters say, the students will remain personally and professionally rooted in the agricultural center of the state — a three-hour drive from the university’s state-of-the-art medical and research facilities in Kansas City.

It will be a different experience, one that administrators say will better prepare students for the realities of a rural practice. Lectures on subjects like anatomy will be delivered via streaming video, lab work will be overseen by more practicing generalists and fewer academic specialists, and the problems of patients will tend more to the everyday than to the extraordinary.

And, the thinking goes, spouses picked up along the way are less likely to complain about moving to a small town.

“It just makes sense, and it’s great that it’s been put into practice,” said Alan Morgan, the president of the National Rural Health Association. “From a rural policy perspective, this is big news.”

Increasingly, medical schools across the country have been looking for ways to add to the ranks of physicians in rural areas. Some are using incentives like guaranteeing admission or forgiving loans to students who commit to practicing in small communities.

Others are recruiting students from rural areas and giving their applications preference, in the hope that they will return after graduating. And a number of schools encourage students to spend one year or more training in rural areas.

Kansas has tried each of these approaches in recent years, all of which are being used at the Salina campus. But with more than half the primary care physicians concentrated in the four largest counties, a vast majority of the state is considered medically underserved. And with many rural doctors near retirement age, the shortage could grow more acute.

It was supported by research suggesting that students who trained in urban areas faced hurdles in adjusting to the more bare-bones life of a country doctor, said Dr. Heidi Chumley, a senior associate dean at the University of Kansas.

“When they go off to the ritz and the glitz and pick up a spouse from the big city, it’s always hard to get them back to small-town America,” said Micheal Terry, president and chief executive of Salina Regional Health Center, which donated the three-story building being used by the school, as well as enough money to run it for a year. (The school cost $1.1 million to start and $1.1 million in reserve to operate it for the first year.)

Situated at the intersection of two highways, Salina, which has a population of nearly 50,000, serves a crucial role as a regional hub supporting surrounding rural communities; the hospital where the school is based receives patients who travel as many as four hours to get there.

University officials were relieved when one visitor from the Liaison Committee on Medical Education, an accrediting body whose approval was considered a major hurdle, remarked with surprise that the area was not just cornfields.

Barbara Barzansky, co-secretary of the accrediting agency, said there had been concerns about the size of the school: Salina is the smallest city in the country to host a full medical degree program. But she said the committee found the resources to be adequate.

“It’s an interesting model, and if the outcomes are good, it could be a stimulus for other schools to do it,” Ms. Barzansky said.

On Friday, the eight students met for the first time for orientation, sitting nervously alongside one another before breaking into enthusiastic chatter. Dr. William Cathcart-Rake, a longtime physician here who is the director of the school, said that while they were the first class of “something very, very special,” they should not think of themselves as experiments.

Though a couple of students said they would have preferred to attend at the campuses in Kansas City or Wichita — one plans to commute from there — the rest said the smaller school had been their first choice.

Most of them grew up in small towns themselves and have agreed, in exchange for free tuition and monthly stipends, to start their careers in rural areas.

They know the life of a rural physician is not easy. Patients tend to be older, poorer and often uninsured. The job generally pays less than lucrative specialties. And many rural doctors have so little support that they are essentially on call permanently.

But the students also spoke firsthand of the need for doctors — one recalled a half-hour drive to the city, relieved by four Advil and an ice pack, to see a doctor about his broken arm.

“I’m a small-town girl, and I always wanted to be back in a small town,” said Kayla Johnson, 23, who grew up west of here in Odin (population 101) and did not like the idea of living in a city to study medicine. “When I heard that the Salina program was starting, I was so excited.”

Dr. Robert Moser, who had a rural practice before becoming the secretary of the Kansas Department of Health and Environment, said he expected the number of students who go into primary care in rural areas to at least double each year.

And while the number is still small, he said, the impact on communities will be significant.

That would be the case in Jewell County, where the only two doctors have moved away, forcing the county to pay outside physicians to provide services a few days each month and to be on call for emergencies.

“It would be great to have a doctor full time here,” said Angela Murray, the administrator of the County Health Department. “Hopefully that will happen.”